Payment Option* ACH (Call for Info)Credit Card (Call to Submit)PO (Pre-Approval Required)PO #

GxP Status* NON-GxPGMP (Specify Validated Method below)GLP

Sample Background Info

Storage Conditions* No Special ConditionsRefrigerateFreezeOther

Sample Return* No (discard)Yes (charges apply)

Turnaround Time* NormalRushPriority

TERMS: Payment due upon completion of the tests and/or delivery of the results and subject to the standard terms and conditions of Pentyl Labs. Pre-payment may be required for new clients until credit established. Samples may be sub-contracted at the discretion of the laboratory. Submission of this form for testing services assumes agreement with these terms and conditions and the pricing information provided by Pentyl Labs.